Provider Demographics
NPI:1174976278
Name:PAVLOV-SHAPIRO, CHERYL A (PT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:PAVLOV-SHAPIRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8539 LAMP POST CIR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9389
Mailing Address - Country:US
Mailing Address - Phone:315-289-5990
Mailing Address - Fax:
Practice Address - Street 1:1398 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8763
Practice Address - Country:US
Practice Address - Phone:315-510-3372
Practice Address - Fax:315-510-3688
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020185-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist